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� <br /> `���, <br /> �� <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue Y� <br /> Pactory Fireplace (s) Freestanding Masonry `;� <br /> Wood Stove (s) Franklin, other ''# <br /> Brand Name Model No. <br />,- Mfgr's Min., Clearances, side , rear , min. flue dia. <br />�y` <br /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) __ cfin <br /> No. Other Fans: Locations cfm � <br /> rU�L STORAGE (MUST BE APPROVED BY PIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside _ <br /> LP Gas: gallons <br /> Other Gas opening <br /> 1'�RMIT I'EE CA.LCULATION <br /> 1. 1.25°Io of Contract Price* or Minimum Fee 35.00 <br /> _ _ _ �-� X .oi2s � . 3G�� 1�-- <br /> (contract price) '' <br /> 2. State Surchar�e. ** Add the State Building Code Division � ����� <br /> Surcharge to each permit. �,�� �i�J� x .0005 $ ��, � <br /> or $.50, wliichever is greater (contract price) <br /> 3, Posta�e and Handlin� (Only mail-in applications) $ 1.50 _ <br /> 4. "I'OTAL PERMIT FEE (Add lines 1-3 above) $ ��. 9�0 ;� <br /> * CONTRACT PRICE or JOB COST mcans thc actual or estimated dollar amotmt chargcd for the�ermitted <br /> work including materiais, labor, proCii, a��d otli�� iiy:cd c:;�;s. I, is t?:c �r.:ount �^ ��e chargcd to tl�e <br /> customer for the work donc. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenant or any othcr party the reasonable tnarket value of such items must be added to the estimated cost <br /> �� or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br />'��`" tlie City may request the submission of a signed copy of the actual contract. � <br /> 3t <br /> ** "1'hc STnTE SURCIIARGE is .0005 of thc contract price undcr $1,000,000 or $.50 - whichcvcr is <br /> grcatcr. For valuations over $1,000,000 call tlie DePartment of Inspectional Services for thc pricc. �" <br /> ; <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br />==� State Building Code, and certifies tliat all statements made on this application are complete, true <br />�`� and correct. � <br />� <br /> �� A licant's Signature: � �..1� � Date: � <br /> p,. PP <br />"E';:',... <br /> " Date: Z � � <br /> Approved By: <br />